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Patho > The Hepatic System > Flashcards

The Hepatic System Flashcards

1
Q

Liver

A

Sole source of albumin and other plasma proteins and also produces 500 to 1500 ml of bile each day

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2
Q

Functions of the Liver

A

More than 500 separate digestive, endocrine, excretory, and hematologic functions

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3
Q

With what does the liver interact with?

A

Endocrine and GI systems

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4
Q

Other functions

A

Other important functions of the liver include production of clotting factors and storage of vitamins.

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5
Q

What does the liver filter?

A

Filters all of the blood from the GI system

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6
Q

The liver is the storage location for what

A

Fat soluble vitamins, handles cholesterol homeostasis
Stores ions and copper, plays a role in hematology with clotting factors and protein synthesis

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7
Q

The liver and the gut are the key organs for what

A

nutrient absorption and metabolism

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8
Q

The liver has the largest numbers of phagocytic cells, why is that important?

A

It contributes to a functional immune system by reducing the amount of bacteria, viruses, and toxins that enter the body

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9
Q

Signs and Symptoms of Hepatic Disease

A

GI symptoms, edema/ascites, dark urine, light-colored or clay-colored feces, and right upper abdominal pain

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10
Q

Dark urine and Light stools

A

Occur when the serum bilirubin level increases from normal (0.1 to 1.0 mg/dl) to a value of 2 or 3 mg/dl

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11
Q

Skin changes

A

Associated with the hepatic system include jaundice, pallor, and orange or green skin

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12
Q

Spider angiomas

A

May be vascular manifestations of increased estrogen levels

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13
Q

Palmer erythema

A

Warm redness of the skin over the palms, also called liver palms

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14
Q

Neurologic symptoms

A

Such as confusion, sleep disturbances, muscle tremors, hyperactive reflexes, and asterixis, may occur

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15
Q

When can peripheral nerve function be impaired?

A

When liver dysfunction results in increased serum ammonia and urea levels

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16
Q

Asterixis (Flapping tremors or liver flap)

A

Motor disturbance
Inability to maintain wrist extension with forward of the UE
Test for asterixis is asking the client to extend the wrist and hand with the rest of the arm supported on a firm surface or with the arms held out in front of the body
Observe for quick, irregular extensions and flexions of the wrist

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17
Q

Where does pain present with hepatic disease

A

Locations of pain associated with hepatic and biliary systems include thoracic pain between scapulae, R shoulder, R UT, R interscapular, or R subscapular areas

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18
Q

Hepatic osteodystrophy

A

Abnormal development of bone, can occur in all forms of cholestasis (bile flow suppression) and hepatocellular disease

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19
Q

Bone pain

A

Osteoporosis
Osteomalacia (rare)

Both- decreased bone mass

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20
Q

Painful osteoarthropathy

A

Develops in the wrists and ankles as a nonspecific complication of chronic liver disease

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21
Q

Other Signs and Symptoms

A

Intense exercise should be avoided when the liver is compromised
Increased risk of coagulopathy also occurs with liver disease
Liver flap or asterixis can be observed in uremia, respiratory failure, and severe heart failure
Tremor is absent at rest, decreased by intentional movement, and maximal on sustained posture, (usually BIL)

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22
Q

Cirrhosis

A

A progressive loss of normal tissue that is replaced with fibrosis and nodular regeneration. Many diseases, medications, and toxins can damage the liver and ultimately lead to cirrhosis, but the most common in the United States include alcohol abuse, hepatitis C virus (HCV), and nonalcoholic liver disease

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23
Q

Hepatitis

A

Chronic and Viral

An acute or chronic inflammation of the liver caused by a virus, a chemical, a drug reaction, or alcohol abuse

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24
Q

Chronic Hepatitis

A

Comprises several diseases that are grouped together because they have common clinical manifestations and all are marked by chronic necroinflammatory injury that can lead insidiously to cirrhosis and end-stage liver disease

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25
Q

Causes of chronic hepatitis

A

Multiple causes including viruses, medications, metabolic abnormalities, and autoimmune disorders

26
Q

Which ones can progress to chronic hepatitis?

A

Hepatitis B (HBV) with or without hepatitis D virus (HDV), HCV, and GB virus (GBV)

27
Q

Viral Hepatitis

A

Each of the recognized hepatitis viruses belongs to a different virus family, and each has a unique epidemiology

28
Q

Hep A

A

Pathogen: HAV, Picornaviridae
Symptoms: Fever, headache, malaise, jaundice
Incubation: 2-6 wks
Transmission: Ingestion
Test: IgM antibodies

29
Q

Hep B

A

Pathogen: HBV, Hepadnaviridae
Symptoms: Severe liver damage, chronic disease occurs
Incubation: 3-26 wks
Transmission: Parenteral, sexual contact
Test: IgM antibodies

30
Q

Hep C

A

Pathogen: HCV, Flaviviridae
Symptoms: Same as HBV, more chronic
Incubation: 2-33 wks
Transmission: Parenteral
Test: PCR of viral RNA

31
Q

Hep D

A

Pathogen: HDV, Deltaviridae
Symptoms: Severe liver damage, high mortality rate
Incubation: 6-26 wks
Transmission: Parenteral, when coinfected with HBV
Test: IgM antibodies

32
Q

Hep E

A

Pathogen: HEV, Caliciviridae
Symptoms: Pregnant women may be at high risk and show high mortality, not chronic disease
Incubation: 2-6 wks
Transmission: Ingestion
Test: IgM antibodies, PCR of viral RNA

33
Q

Jaundice

A

Clinically characterized by yellow discoloration of the skin, sclerae, and mucous membranes. Jaundice occurs as a result of an overproduction of bilirubin, defects in bilirubin metabolism (in uptake by the liver or conjugation), the presence of liver disease, or obstruction of bile flow

34
Q

Drug-Induced Liver Injury

A

Many drugs or toxins can cause injury to the liver
More than 1,000 medicinal agents, chemical, and herbal remedies are recognized as producing hepatic injury

35
Q

Alcoholic Liver Disease (ALD)

A

Ranging from alcoholic steatosis (fatty liver, occurring in 90% of heavy drinkers) and alcoholic steatohepatitis to alcoholic hepatitis and cirrhosis

36
Q

ALD Incidence/Risk Factors

A

Genetics
Women are vulnerable to developing ALD at lower daily intake levels of alcohol than men
Coexisting HCV, smoking, and obesity

37
Q

ALD Pathogenesis

A

Accumulation of fat
Damage to the liver consisting of inflammation, necrosis of individual cells, and early fibrosis
Large nodules of fibrotic liver tissue
Reduction in oxidation of hepatic fatty acids=Increase lipogenesis

38
Q

ALD Manifestations

A

Fatty liver infiltrate
Nausea, vomiting, abdominal pain, jaundice, anorexia, fever, and weight loss

39
Q

What symptoms do people with alcoholic hepatitis or cirrhosis manifest?

A

Tender hepatomegaly, fever, and jaundice
Muscle wasting, spider angiomata, palmar erythema, gynecomastia, or testicular atrophy

40
Q

Malignant Liver Neoplasms

A

4th leading cause of death from cancer worldwide and the 5th leading cause of cancer deaths among men in the US
Linked to cirrhosis, particularly HBV, HCV, and alcoholic-related cirrhosis

41
Q

Metastatic Malignant Tumors

A

The liver is one of the most common sites of metastasis from other primary cancers (colorectal, stomach, pancreas, esophagus, lung, breast, melanoma)
Metastatic tumors occur 20x more often than primary liver tumors and constitute the bulk of hepatic malignancy

42
Q

Pancreas

A

Both an exocrine and an endocrine gland. Its primary function in digestion is exocrine secretion of digestive enzymes and pancreatic juices, transported through the pancreatic duct to the duodenum

43
Q

Pancreas Endocrine Function

A

Involves the secretion of glucagon and insulin by islet of Langerhans cells for the regulation of carbohydrate metabolism

44
Q

Pancreatitis

A

Potentially serious inflammation of the pancreas and surrounding organs that may result in autodigestion of the pancreas by its own enzymes
Acute: brief and reversible
Chronic: recurrent or persisting

45
Q

Acute Pancreatitis

A

An inflammatory process of the pancreas that can involve surrounding organs as well as cause a systemic reaction

46
Q

Acute Pancreatitis Risk Factors

A

Alcohol
Gallstones
Hypertriglyceridemia

47
Q

3 Levels of Acute Pancreatitis

A
  1. Mild-local or systemic complications in organ failure is absent
  2. Moderate-local complications with or without organ failure for less than 24 hours
  3. Severe-Persistent organ failure for more than 48 hours with involvement of one or more organs
48
Q

Chronic Pancreatitis

A

Characterized by the development of irreversible changes in the pancreas secondary to chronic inflammation

49
Q

Chronic Pancreatitis Risk Factors

A

Alcohol
Smoking
Genetic predisposition

50
Q

Pancreatic Cancer

A

Represents the third leading cause of cancer mortality in the United States, with more than 45,000 deaths each year

Lowest 5-yr survival rate after diagnosis (9%) of any type of cancer

51
Q

Pancreatic Cancer Symptoms

A

Initially nonspecific and vague or subtle in onset (e.g., anorexia, malaise, nausea, fatigue, pruritus), which contribute to the delay in diagnosis
Abdominal pain
Weight loss
Jaundice

52
Q

Gallbladder

A

Acts as a reservoir for bile, stores and concentrates the bile during fasting periods and then contracts to expel the bile into the duodenum in response to the arrival of food

53
Q

Bile

A

Helps in alkalinizing the intestinal contents and plays a role in the emulsification, absorption, and digestion of fat

54
Q

Biliary System - Cholelithiasis (gallstone disease)

A

One of the most common GI diseases in the United States, occurring in an estimated 25 million people, or 10% to 15% of the adult population

55
Q

Gallstones

A

Occurs when stones form in the bile at the gallbladder as a result of changes in the normal components of bile

56
Q

Complications of Cholelithiasis
Choledocholithiasis

A

Defined as calculi in the common bile duct, choledocholithiasis occurs in 5% to 20% of persons with gallstones and has the same etiology and pathogenesis

Complications can be severe, including pancreatitis and cholangitis

57
Q

Acute Cholangitis

A

Obstruction and stasis of bile from choledocholithiasis, biliary strictures, or malignancy can lead to a suppurative infection of the biliary tree

58
Q

Acute Cholangitis Symptoms

A

Those in biliary obstruction (pain) plus fever and jaundice

59
Q

Acute cholangitis can be categorized into three stages: grade I, mild; grade II, moderate; and grade III, severe

A
  1. Mild cholangitis does not meet the criteria for either severe or moderate cholangitis
  2. Moderate cholangitis have an elevated white blood cell count, fever, age over 75 years, hyperbilirubinemia, and hypoalbuminemia
  3. Severe acute cholangitis manifests with at least one new organ dysfunction
60
Q

Acute Cholecystitis

A

Inflammation of the gallbladder, may be acute or chronic and occurs most often as a result of impaction of gallstones in the cystic duct, causing obstruction to bile flow and painful distention of the gallbladder

61
Q

Asterixis

A

Motor disorder characterized by the intermittent loss of muscle tone when attempting to maintain a set position

Patho (13 decks)

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